Katie Couric Interview

Irma Obal Lucca had good skin as a teenager – an occasional hormonally induced flareup, perhaps, but nothing more. But in her early 20s, after her daughter was born, she developed a case of cystic acne.

"During a bad outbreak, it would get very lumpy," said the 40- year-old manager of a real-estate development company. "It gave a different contour to one side of my face."

The breakouts were all the more troublesome because Lucca performs with a Gilbert and Sullivan company. "I’m kind of visible," she said.

Lucca tried just about everything – regular facials, cleansers and lotions, antibiotics. None of it made a significant difference.

Then she read about a new laser treatment, which was approved by the Food and Drug Administration last month. By her third treatment, her acne had largely cleared up. KNOW YOUR LASERS

Pimples are one thing for a teenager, when so many of one’s peers are similarly afflicted. As an adult, they’re entirely another matter.

"It’s embarrassing for professional people who are in business, who are high-profile," said Dr. Bruce Katz, director of the cosmetic surgery and laser clinic at Mount Sinai Medical Center and one of a growing number of doctors who are putting lasers to new use treating recurrent breakouts in adults. "A breakout becomes a significant problem."

There is no cure for acne and the remedies that have been available until recently – topical treatments, antibiotics and Accutane – either don’t provide a long-term solution or, in the case of Accutane, carry the risk of serious side effects, including birth defects and mental problems.

Brienne Pedigo was afraid to take Accutane, but she tried just about everything else, including washes, oral and topical antibiotics, Retin-A and microdermabrasion. "They would either dry my skin out so badly that that became the problem, or they didn’t work at all," the 23-year-old actress said. She went to see Katz and has seen a remarkable improvement.

"We haven’t found anyone it hasn’t worked on," Katz said of the method he uses.

If there is a downside, it’s the confusion factor. So many different types of lasers have proven valuable in treating acne that it’s tough to know what kind of treatment to seek. And new treatments are being developed all the time.

"People come in and they’re absolutely blown away because they don’t know where to begin," said Dr. David Goldberg, director of laser research in the department of dermatology at the Mount Sinai School of Medicine.

A YEAR’S RELIEF

Given that there are so many effective options, finding a doctor you can trust is more important than using a specific type of laser. "With all these treatments, one should not necessarily focus on the treatments, one should focus on the problem," said Dr. Philip Miller, Clinical Associate Professor at New York University Medical Center . "What matters most is that there are new treatments out there."

Even more confusing: Each manufacturer gives its lasers trade monikers, so lasers that perform essentially the same function have different names. Don’t get hung up on trade names, but focus instead on how the laser works and what it does.

Some lasers have been approved by the FDA specifically to treat acne, and others are used off-label – that is, for something other than the condition for which it received that approval. Most of these treatments are not covered by insurance and run anywhere from $400 to $700 a session, depending on the doctor and the type of treatment.

Typically, a patient needs four to six sessions, at two- to four- week intervals. The treatments take about 20 minutes, and sometimes cause slight redness for a few hours afterward. Patients say the sensation is like having a rubber band being snapped on your face.

Here are the different kinds of lasers available: In the first category are lasers that work by harming the sebaceous glands, where the oil that can cause acne is produced. These lasers work on wavelengths over 1,000 and are considered

by some doctors to be the most effective weapon against acne. Trade names include Smoothbeam, which has a wavelength of 1,450, and CoolTouch at 1,320.

In the second category are devices that work by inhibiting the growth of bacteria. These work on shorter wavelengths and include NLight, Aura and Clearlight.

Some doctors combine the longer-wavelength lasers with aminolevulinic acid ( ALA ) treatment, although ALA therapy is often used and is also effective on its own. In this treatment, a topical ALA solution is applied to the patient’s face and is absorbed by acne-causing bacteria, which becomes photosensitive. An intense flash of light, called Intense Pulsed Light (IPL) or a Vbeam laser is then shined on the patients face, killing the bacteria. This treatment is a little more time-consuming, since the ALA needs to stay on a patient’s face for an hour before light or laser application.

Katz, who uses ALA therapy in conjunction with the Smoothbeam laser, says he has had patients stay acne-free for up to a year.

As efficiently as lasers are in the treatment of acne, in the wrong hands they can be dangerous. An incorrectly used laser can leave a patient with scarring, so it’s important to do your research ahead of time and make sure you’re seeing a doctor who is very experienced in laser treatment.

Ask him if he rents or owns his equipment; favor a physician who owns it, because he likely treats enough patients to make it pay for itself. Ask him how long he has been using lasers, how often he’s done the procedure and how many times a year he does it, where he learned it and if he is board-certified.

Dr. Philip Miller, MD, FACS specializes exclusively in facial plastic surgery in New York and other cosmetic surgery, and has over 20 years' experience. He is recognized as an expert in rhinoplasty and facial rejuvenation procedures and is frequently invited to share his specific techniques with his peers at national facial plastic surgery meetings.